Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME0022052 | FL |
NPI | 1164484812 |
---|---|
Provider Name | Dr. Thomas S Breza |
First Address | Lauderdale By The Sea, FL 33308-5017 |
Second Address | Lauderdale By The Sea, FL 33308-5017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 12/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D58559 | (02) |